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Prevalence and Correlates of Direct Self-Injurious Behavior among Chinese Adolescents: Findings from a Multicenter and Multistage Survey

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Abstract

Direct self-injurious behavior (DSIB) has become an important focus due to its perniciousness and perplexity. Little is known about its prevalence and correlative factors in Chinese adolescents, including how data may differ according to gender. A multicenter, multistage stratified cluster random sampling was used to examine the previous 12-month prevalence of DSIB, as well as the possible correlates of demographics, risky behaviors, suicidality, and psychosocial factors associated with DSIB in a school-based sample of 11,880 students (49.5 % boys and 50.5 % girls). Approximately 30 % of the adolescents in the sample reported at least one incident of DSIB in the past 12-month period. After controlling for demographic variables, analyses of the independent relationships of DSIB with risky behaviors, suicidality, and psychosocial factors were conducted for each gender. Smoking, binge drinking, running away from home, suicide ideation, suicide plans, positive affect, and physical symptoms were identified as common factors associated with DSIB for both genders in the final model. In addition, truancy, fighting, physical inactivity, motor impulsiveness, and depressed affect were found to be related to DSIB in boys, whereas suicide attempts and somatic complaints were found to be related to DSIB in girls. Separation anxiety and social anxiety associated negatively with DSIB in boys and girls, respectively. DSIB was not found to independently relate to attention impulsiveness, non-planned impulsiveness, self-esteem, or harm avoidance in either genders. DSIB was prevalent in Chinese adolescents. Programs intended to promote physical and mental health in adolescents should take into account gender differences in DSIB-associated factors, including risky behaviors, suicidality, and psychosocial factors.

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References

  • Auerbach, R. P., Claro, A., Abela, J. R. Z., Zhu, X., & Yao, S. (2009). Understanding risky behavior engagement amongst chinese adolescents. Cognitive Therapy and Research, 34, 159–167. doi:10.1007/s10608-009-9238-x.

    Article  Google Scholar 

  • Auerbach, R. P., Stewart, J. G., & Johnson, S. L. (2016). Impulsivity and suicidality in adolescent inpatients. Journal of Abnormal Child Psychology. doi:10.1007/s10802-016-0146-8.

    PubMed  Google Scholar 

  • Bergen, H., Hawton, K., Waters, K., Ness, J., Cooper, J., Steeg, S., & Kapur, N. (2012). Premature death after self-harm: a multicentre cohort study. The Lancet, 380, 1568–1574. doi:10.1016/s0140-6736(12)61141-6.

    Article  Google Scholar 

  • Biederman, J., Hirshfeld-Becker, D. R., Rosenbaum, J. F., Herot, C., Friedman, D., Snidman, N., et al. (2001). Further evidence of association between behavioral inhibition and social anxiety in children. American Journal of Psychiatry, 158, 1673–1679. doi:10.1176/appi.ajp.158.10.1673.

    Article  PubMed  Google Scholar 

  • Bresin, K., & Schoenleber, M. (2015). Gender differences in the prevalence of nonsuicidal self-injury: A meta-analysis. Clinical Psychology Review, 38, 55–64. doi:10.1016/j.cpr.2015.02.009.

    Article  PubMed  Google Scholar 

  • Brunner, R., Kaess, M., Parzer, P., Fischer, G., Carli, V., Hoven, C. W., et al. (2014). Life-time prevalence and psychosocial correlates of adolescent direct self-injurious behavior: A comparative study of findings in 11 European countries. Journal of Child Psychology and Psychiatry, 55, 337–348. doi:10.1111/jcpp.12166.

    Article  PubMed  Google Scholar 

  • Claes, L., Luyckx, K., & Bijttebier, P. (2014). Non-suicidal self-injury in adolescents: prevalence and associations with identity formation above and beyond depression. Personality and Individual Differences, 61–62, 101–104. doi:10.1016/j.paid.2013.12.019.

    Article  Google Scholar 

  • Giannetta, M. M., Betancourt, L. M., Brodsky, N. L., Wintersteen, M. B., Romer, D., Giannetta, J. M., & Hurt, H. (2012). Suicidal ideation and self-harm behavior in a community sample of preadolescent youth: A case-control study. Journal of Adolescent Health, 50(5), 524–526. doi:10.1016/j.jadohealth.2011.09.013.

    Article  PubMed  Google Scholar 

  • Hawton, K., Rodham, K., Evans, E., & Weatherall, R. (2002). Deliberate self harm in adolescents: Self report survey in schools in England. British Medical Journal, 325, 1207–1211. doi:10.1136/bmj.325.7374.1207.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hawton, K., Saunders, K. E. A., & O’Connor, R. C. (2012). Self-harm and suicide in adolescents. The Lancet, 379, 2373–2382. doi:10.1016/s0140-6736(12)60322-5.

    Article  Google Scholar 

  • Hawton, K., Saunders, K., Topiwala, A., & Haw, C. (2013). Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review. Journal of Affective Disorders, 151, 821–830. doi:10.1016/j.jad.2013.08.020.

    Article  PubMed  Google Scholar 

  • Hawton, K., Haw, C., Casey, D., Bale, L., Brand, F., & Rutherford, D. (2015). Self-harm in Oxford, England: Epidemiological and clinical trends, 1996–2010. Social Psychiatry and Psychiatric Epidemiology, 50, 695–704. doi:10.1007/s00127-014-0990-1.

    Article  PubMed  Google Scholar 

  • Klonsky, E. D. (2011). Non-suicidal self-injury in United States adults: prevalence, sociodemographics, topography and functions. Psychological Medicine, 41, 1981–1986. doi:10.1017/S0033291710002497.

    Article  PubMed  Google Scholar 

  • Madge, N., Hewitt, A., Hawton, K., de Wilde, E. J., Corcoran, P., Fekete, S., et al. (2008). Deliberate self-harm within an international community sample of young people: comparative findings from the Child & Adolescent Self-harm in Europe (CASE) Study. Journal of Child Psychology and Psychiatry, 49, 667–677. doi:10.1111/j.1469-7610.2008.01879.x.

    Article  PubMed  Google Scholar 

  • March, J. S., Parker, J. D. A., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 554–565. doi:10.1097/00004583-199704000-00019.

    Article  PubMed  Google Scholar 

  • Mars, B., Heron, J., Crane, C., Hawton, K., Kidger, J., Lewis, G., et al. (2014). Differences in risk factors for self-harm with and without suicidal intent: findings from the ALSPAC cohort. Journal of Affective Disorders, 168, 407–414. doi:10.1016/j.jad.2014.07.009.

    Article  PubMed  PubMed Central  Google Scholar 

  • McMahon, E. M., Reulbach, U., Corcoran, P., Keeley, H. S., Perry, I. J., & Arensman, E. (2010). Factors associated with deliberate self-harm among Irish adolescents. Psychological Medicine, 40, 1811–1819. doi:10.1017/S0033291709992145.

    Article  PubMed  Google Scholar 

  • Muehlenkamp, J. J. (2005). Self-injurious behavior as a separate clinical syndrome. American Journal of Orthopsychiatry, 75, 324–333. doi:10.1037/0002-9432.75.2.324.

    Article  PubMed  Google Scholar 

  • Muehlenkamp, J. J., Claes, L., Havertape, L., & Plener, P. L. (2012). International prevalence of adolescent non-suicidal self-injury and deliberate self-harm. Child and Adolescent Psychiatry and Mental Health, 6, 10. doi:10.1186/1753-2000-6-10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Nock, M. K. (2010). Self-injury. Annual Review of Clinical Psychology, 6, 339–363. doi:10.1146/annurev.clinpsy.121208.131258.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30, 133–154. doi:10.1093/epirev/mxn002.

    Article  PubMed  PubMed Central  Google Scholar 

  • O’Connor, R. C., Rasmussen, S., & Hawton, K. (2014). Adolescent self-harm: a school-based study in Northern Ireland. Journal of Affective Disorders, 159, 46–52. doi:10.1016/j.jad.2014.02.015.

    Article  PubMed  Google Scholar 

  • Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51, 768–774.

    Article  PubMed  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., & Bagby, R. M. (2008). The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117, 300–313. doi:10.1037/0021-843X.117.2.300.

    Article  PubMed  Google Scholar 

  • Schwartz, C. E., Snidman, N., & Kagan, J. (1999). Adolescent social anxiety as an outcome of inhibited temperament in childhood. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1008–1015. doi:10.1097/00004583-199908000-00017.

    Article  PubMed  Google Scholar 

  • Selby, E. A., Anestis, M. D., & Joiner, T. E. (2008). Understanding the relationship between emotional and behavioral dysregulation: emotional cascades. Behaviour Research and Therapy, 46, 593–611. doi:10.1016/j.brat.2008.02.002.

    Article  PubMed  Google Scholar 

  • Shek, D. T., & Yu, L. (2012). Self-harm and suicidal behaviors in Hong Kong adolescents: Prevalence and psychosocial correlates. Scientific World Journal, 2012, 932540. doi:10.1100/2012/932540.

    PubMed  PubMed Central  Google Scholar 

  • Song, H., Cai, H., Brown, J. D., & Grimm, K. J. (2011). Differential item functioning of the Rosenberg self-esteem scale in the US and China: Measurement bias matters. Asian Journal of Social Psychology, 14, 176–188. doi:10.1111/j.1467-839X.2011.01347.x.

    Google Scholar 

  • St. Germain, S. A., & Hooley, J. M. (2012). Direct and indirect forms of non-suicidal self-injury: evidence for a distinction. Psychiatry Research, 197, 78–84. doi:10.1016/j.psychres.2011.12.050.

    Article  PubMed  Google Scholar 

  • Swannell, S. V., Martin, G. E., Page, A., Hasking, P., & St John, N. J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide & Life-Threatening Behavior, 44, 273–303. doi:10.1111/sltb.12070.

    Article  Google Scholar 

  • Taliaferro, L. A., Muehlenkamp, J. J., Borowsky, I. W., McMorris, B. J., & Kugler, K. C. (2012). Factors distinguishing youth who report self-injurious behavior: a population-based sample. Academic Pediatrics, 12, 205–213. doi:10.1016/j.acap.2012.01.008.

    Article  PubMed  Google Scholar 

  • Tang, J., Ma, Y., Guo, Y., Ahmed, N. I., Yu, Y., & Wang, J. (2013). Association of aggression and non-suicidal self injury: a school-based sample of adolescents. PLoS ONE, 8, e78149. doi:10.1371/journal.pone.0078149.

    Article  PubMed  PubMed Central  Google Scholar 

  • Taylor, P. J., Hutton, P., & Wood, L. (2014). Are people at risk of psychosis also at risk of suicide and self-harm? A systematic review and meta-analysis. Psychological Medicine, 45, 911–926. doi:10.1017/s0033291714002074.

    Article  PubMed  Google Scholar 

  • The National Population Census Office & The Population and Employment Statistics Division of National Statistic Bureau (2012). Tabulation on the 2010 population censue of the people’s republic of china. Beijing: China statistic press.

    Google Scholar 

  • Victor, S. E., & Klonsky, E. D. (2014). Correlates of suicide attempts among self-injurers: a meta-analysis. Clinical Psychology Review, 34, 282–297. doi:10.1016/j.cpr.2014.03.005.

    Article  PubMed  Google Scholar 

  • Wang, J., Deng, X., Wang, J., Wang, X., & Xu, L. (2010). The associations between health risk behaviors and suicidal ideation and attempts in an urban Chinese sample of adolescents. Journal of Affective Disorders, 126, 180–187. doi:10.1016/j.jad.2010.02.121.

    Article  Google Scholar 

  • Wang, M., Yi, J., Cai, L., Hu, M., Zhu, X., Yao, S., & Auerbach, R. P. (2012). Development and psychometric properties of the health-risk behavior inventory for Chinese adolescents. BMC Medical Research Methodology, 12, 94. doi:10.1186/1471-2288-12-94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang, M., Armour, C., Wu, Y., Ren, F., Zhu, X., & Yao, S. (2013). Factor structure of the CES-D and measurement invariance across gender in mainland Chinese adolescents. Journal of Clinical Psychology, 69, 966–979. doi:10.1002/jclp.21978.

    Article  PubMed  Google Scholar 

  • Wang, J. N., Liu, L., & Wang, L. (2014). Prevalence and associated factors of emotional and behavioural problems in Chinese school adolescents: A cross-sectional survey. Child: Care, Health and Development, 40, 319–326. doi:10.1111/cch.12101.

    Google Scholar 

  • Whitlock, J., Eckenrode, J., & Silverman, D. (2006). Self-injurious behaviors in a college population. Pediatrics, 117, 1939–1948. doi:10.1542/peds.2005-2543.

    Article  PubMed  Google Scholar 

  • Wilkinson, P., & Goodyer, I. (2011). Non-suicidal self-injury. European Child and Adolescent Psychiatry, 20, 103–108. doi:10.1007/s00787-010-0156-y.

    Article  PubMed  Google Scholar 

  • Yao, S., Yang, H., Zhu, X., Auerbach, R. P., Abela, J. R., Pulleyblank, R. W., & Tong, X. (2007a). An examination of the psychometric properties of the Chinese version of the Barratt Impulsiveness scale, 11th version in a sample of Chinese adolescents. Perceptual and Motor Skills, 2007, 1169–1182. doi:10.2466/pms.104.4.1169-1182.

    Google Scholar 

  • Yao, S., Zou, T., Zhu, X., Abela, J. R., Auerbach, R. P., & Tong, X. (2007b). Reliability and validity of the Chinese version of the multidimensional anxiety scale for children among Chinese secondary school students. Child Psychiatry and Human Development, 38, 1–16. doi:10.1007/s10578-006-0039-0.

    Article  PubMed  Google Scholar 

  • Zetterqvist, M., Lundh, L. G., Dahlstrom, O., & Svedin, C. G. (2013). Prevalence and function of non-suicidal self-injury (NSSI) in a community sample of adolescents, using suggested DSM-5 criteria for a potential NSSI disorder. Journal of Abnormal Child Psychology, 41, 759–773. doi:10.1007/s10802-013-9712-5.

    Article  PubMed  Google Scholar 

  • Zhou, X., Dere, J., Zhu, X., Yao, S., Chentsova-Dutton, Y. E., & Ryder, A. G. (2011). Anxiety symptom presentations in Han Chinese and Euro-Canadian outpatients: Is distress always somatized in China? Journal of Affective Disorders, 135, 111–114. doi:10.1016/j.jad.2011.06.049.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank the following people for their work in participant recruitment and data collection at the study sites used: Zhengyan Jiang (Zhejiang University), Jing Liu (Peking University), Yuan Wang and Aining Guo (Ningxia Medical University), Wenbing Gao (Chinese Academy of Sciences), Yanqing Tang (China Medical University), Jin Jing (Sun Yat-Sen University), Wenqing Fu (Suzhou University), Yi Huang (Sichuan University), and Wei Hong (Peking University). We also thank all of the students and schools for their participation and support.

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Authors and Affiliations

  1. Medical Psychological Institute, Second Xiangya Hospital, Central South University, No. 139 Ren-Min Middle Road, Changsha, 410011, Hunan, People’s Republic of China

    Xiuhong Xin, Qingsen Ming & Shuqiao Yao

  2. Mental Health Center, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China

    Xiuhong Xin & Jianqun Fang

  3. Medical Psychology Department, Clinical Medical College, Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China

    Xiuhong Xin & Jianqun Fang

  4. School of Humanities & Social Sciences, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China

    Yuping Wang

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  1. Xiuhong Xin
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Correspondence to Shuqiao Yao.

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Grant Support

This study was supported by grants from the National Key Technologies Research and Development Program of the 11th 5-year plan of China (No. 2009BAI77B02) and the construct program of the key discipline in Hunan Province.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The signed Informed consent was obtained from the subjects or their parents/legal guardians if the subjects were younger than 18 years old in the study.

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Xin, X., Wang, Y., Fang, J. et al. Prevalence and Correlates of Direct Self-Injurious Behavior among Chinese Adolescents: Findings from a Multicenter and Multistage Survey. J Abnorm Child Psychol 45, 815–826 (2017). https://doi.org/10.1007/s10802-016-0201-5

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